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RJS
Heart Valve lesions
• Mitral stenosis• Aortic stenosis• Pulmonary stenosis• Tricuspid stenosis• Prosthetic stenosis
• Mitral regurgitation• Aortic regurgitation• Pulmonary regurgitation • Tricuspid regurgitation• Prosthetic regurgitation
• Mitral valve prolapse
RJS
Mitral regurgitation - Aetiology
• Valve– Rheumatic fever– Endocarditis
• Mitral valve annulus– Dilation– Calcification
• Chordae tendinae– Rupture– Lengthening
• Papillary muscle– ischaemia– dilation
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Mitral regurgitation – pathophysiology
LV emptying LA pressure (if acute, pulmonary odema)
LV filling LVedd
• LV stretch failure
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Mitral regurgitation – Clinical
• Symptoms appear late– SOB– Fatigue– Right heart failure
• Signs– Full volume pulse– Pan systolic murmur
radiating to apex– Right heart failure – Pulmonary hypertension
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Mitral Regurgitation
• Investigations– ECG p mitrale– Xray large heart, calcified
mv annulus, pulmonary odema
– Echocardiogram large LA, abnormal valve, MR
– LV angio MR, large LA
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Mitral Regurgitation
• Heart Failure
• Decrease afterload
• Replacement
• Anticoagulation
• Antibiotic prophylaxis
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Mitral Stenosis – Symptoms/Signs
• SOB
• Haemoptysis
• Embolisation
• Mitral Facies
• AF, thready pulse JVP
• RV heave
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Mitral Stenosis – Symptoms/Signs
• Opening snap
• Rumbling diastolic murmur
• Presystolic murmur
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Mitral stenosis - Investigations
• ECG – AF
• Xray – Pulmonary congestion, large LA and R heart
• Echo – tight valve, high inflow large LA
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MS Treatment
• Antibiotic prophylaxis
• Anticoagulation (AF)
• Digoxin (AF)
• Mitral Valvuloplasty
• Surgical Replacement
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Aortic Stenosis - aetiology
• Congenital – bicuspid valve
• Acquired – Rheumatic– Senile/degenerative
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Aortic stenosis – symptoms/ signs
• Asymptomatic
• Angina
• Heart Failure
• Syncope
• Sudden Death
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Aortic stenosis – symptoms/ signs
• Slow rising pulse
• LV heave
• Ejection systolic murmur radiating to carotids
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Aortic Stenosis - investigations
• ECG – LVH
• Echo – LVH, calcified valve, high doppler velocity
• Angio – Ao valve gradient
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Aortic stenosis - treatment
• Antibiotic prophylaxis
• Surgical replacement before heart failure
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Aortic Regurgitaiton- aetiology
• Aortic valve– Rheumatic fever– Infective endocarditis– Bicuspid vlave
• Aortic dilation– Age related– Marfans– Dissection
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Aortic regurg - pathophysiology
• Increased Lved volume
• Increased stroke volume
• LV dilatation
• LV failure
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AR – symptoms/signs
• deMusset’s sign
• Collapsing pulse
• Displaced apex beat
• Early diastolic murmur
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AR investigations
• ECG – LVH
• X-ray – abnormal aorta, large heart
• Echo – AR, LV dilation, dissection
• Angiogram – AR, LV dilation
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When to replace the mitral valve
• When symptoms significant
• Before LV failure
• Before significant pulmonary hypertension